Differences in pain-related fear acquisition and generalization: an experimental study comparing patients with fibromyalgia and healthy controls

Anomalies in fear learning, such as failure to inhibit fear to safe stimuli, lead to sustained anxiety, which in turn may augment pain. In the same vein, stimulus generalization is adaptive as it enables individuals to extrapolate the predictive value of 1 stimulus to similar stimuli. However, when fear spreads in an unbridled way to novel technically safe stimuli, stimulus generalization becomes maladaptive and may lead to dysfunctional avoidance behaviors and culminate in severe pain disability. In a voluntary movement conditioning paradigm, we compared the acquisition and generalization of pain-related fear in patients with fibromyalgia (FM) and healthy controls. During acquisition, participants received predictable pain in 1 context (ie, 1 movement predicts pain, whereas another does not), and unpredictable pain in another (ie, pain never contingent upon movement). Fear generalization to novel movements (resembling the original painful or nonpainful movement) was tested in both contexts. Results indicated that the FM group showed slower differential acquisition of pain-related fear in the predictable context, and more contextual pain-related fear in the unpredictable context. Fear of movement-related pain spreads selectively to novel movements similar to the original painful movement, and not to those resembling the nonpainful movement in the healthy controls, but nondifferential fear generalization was observed in FM. As expected, in the unpredictable context, we also observed nondifferential fear generalization; this effect was more pronounced in FM. Given the status of overgeneralization as a plausible transdiagnostic pathogenic marker, we believe that this research might increase our knowledge about pathogenesis of musculoskeletal widespread pain.